What explains the prevalence of post-traumatic stress disorder, depression, anxiety and poor quality of life after intensive care? An investigation of clinical, psychological and sociodemographic risk factors

Wade, D.;
(2011)
What explains the prevalence of post-traumatic stress disorder, depression, anxiety and poor quality of life after intensive care? An investigation of clinical, psychological and sociodemographic risk factors.
Doctoral thesis, UCL (University College London).

Abstract

Although many lives are saved in intensive care, patients frequently fail to make a
good recovery. In addition to physical weakness and cognitive impairment, patients
suffer from clinical anxiety, depression and PTSD. The aim of this PhD was to
establish the prevalence of poor mental health after intensive care and identify
clinical, psychological and socio-demographic risk factors. First I carried out a
systematic review of post-ICU psycho-social outcomes but found the quality of
studies was variable and few consistent risk factors were identified.
I subsequently conducted a prospective cohort study of 157 intensive care patients
who were assessed for mood, stress, delirium and memory in the ICU. Clinical and
socio-demographic data were recorded. At three months, 64% completed valid
measures of PTSD, depression and anxiety, and socio-economic circumstances
(SEC). Incidence of mood disturbance, delirium and physical stress in the ICU were
78%, 66% and 77% respectively. At three months, prevalence of PTSD was 27.1%
(95%CIs: 18.3, 35.9%), depression 46.3% (95%CIs: 36.5, 56.1%) and anxiety
44.4% (95%CIs: 34.6%, 54.2%). A total of 55% of patients had at least one
outcome. PTSD was predicted by number of organs supported, drug groups used
and sepsis bio-markers. Strongest clinical predictors were days of sedation (PTSD),
benzodiazepine usage (depression), inotropes (anxiety) and steroids (better
physical HRQL). SEC was a risk factor for depression, anxiety and mental HRQL.
Psychological predictors including ICU mood, stress, delirium and memories were
highly correlated with outcomes and partially mediated the relationships between
clinical factors and outcomes.
A qualitative study of 17 patients with intrusive memories of ICU at three months
revealed patients had highly disturbing hallucinatory flash-backs or distressing
recurring images of bleeding, choking, tubes and pain. The PhD highlighted the
need to reduce ICU stress and identified modifiable risk factors that could inform
clinical interventions to help patients.

Type:

Thesis
(Doctoral)

Title:

What explains the prevalence of post-traumatic stress disorder, depression, anxiety and poor quality of life after intensive care? An investigation of clinical, psychological and sociodemographic risk factors